HomeMy WebLinkAboutFire Sprinkler Alteration 04-1122
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
\ ~b75
Date Rec' d
~ 27.04-
I. White File I PERMIT NO I
2. Pink Ci.y . 04--. II z. z..
) Yenow Applicant
ZONING (office use)
I r::;:;:;.; - md.... .. bottom)
~240 Tn~\I S-r-. Sl~'
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
BLOCK
OWNE~
(Name) O~6
zd~
(Address)
PIDZS. ozz. ODS. 0
~ l~J~a.. \r V)" V\~
S "5.~\
(Phone)
RUIlBER G:.V"\.. +v-.~iu.,
(Company Name) c:>l~V'l t-i V"~ P\f'o--\-e.c..+1 0 V"l
(Contact Name) K \~ v-i:- 0 l O::;co I/l
.
(Phone)
(Phone)
~1-;:{-27? {~?7111
c.. L~,- 2'::;0 - Ll70 I
4l
(Address)
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing ORe-Siding OLower Level Fimsh 0 Fireplace
DAddition S<\lteration DUtility Connection 0 Mise,
CODE: OLR.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
B
S U
PROJECT COST IV ALUE S
(excluding land)
'fDCJLDO
II
F
1
ill IV V A
HIM R
2 J 4 5
I hL'Teby certify that I have furnished information on this application which is 10 the best of my knowledge true and correct, I also certify that I am the owner or authonzed agent for the
above-mentIoned property and that aU constnlction will conform to all existing state and local laws and will proceed in accordance with submitted plans, I am aware that the building
official can revoke Ihis permit for just cause Furthermore, I hereby agree that the City official or a designee may enter upon the property to perform needed mspcctions,
x
<W~~
Signature
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
~Di{5
Contractor's License No,
$
$
$
$
$
S
$
$
Water Meter Size5/S";I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
Park Support Fee
SAC
#
#
.0Ll
00
TOTAL DUE
\ b/25fo'1
Date
$
$
S
$
$
$
S
$
$ 40.00
!Paid ~.6V I~ ~I I
Date IO."','~ By
IJ/5pec:r/()N peQ(/I/Z-t5D
ThIS IS to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requl'Sted, This document
when signed by the City Planner constItutes a temporary Certificate of Zoning compliance and allows construction to commence, Before occupancy, a Cl'Tlificate of Occupancy must be
issued
Planning Director
Date Special Conditions. if any
24 hour notirt for all inspedions (9!12) 447-98!1O. fax (9!12) 447-424!1
16200 Eagle Creek Avenue Prior Lake, MN 55372